Understanding Barriers and Facilitators to Physical Activity Engagement to Inform a Precision Prescription Approach during Pregnancy

Abstract

Physical activity during pregnancy is an important health behavior. However, many pregnant individuals are provided with little-to-no guidance to adequately engage in physical activity. The purpose of this quantitative and quasi-qualitative study of currently or previously pregnant women was to examine physical activity behaviors in pregnancy and understand barriers and facilitators to achieving physical activity recommendations. Overall, 431 women (18+ years), White/Caucasian (84.5%), married (84.9%), and currently pregnant (66.6%), completed an online survey study. Most women (69.4%) reported engaging in cardio-based physical activity and willing to engage in physical activity to meet guidelines between 2 and 5 days per week (77.4 –88.8%). The most frequently reported barriers were feeling too tired (72.8%) or uncomfortable (71.8%) and childcare needs (57.8%). Being able to choose time of day (96.0%), accessing home workouts (92.9%), and having a personalized prescription (95.6%) were the most reported facilitators. Open comment feedback resulted in additional barriers, such as ensuring proper energy intake, while motivation and support from other pregnant individuals were fundamental facilitators. Individualized physical activity prescription is lacking in routine prenatal care. To support pregnant individuals to achieve physical activity recommendations, developing a prescription with suitable modalities, at-home options, and consideration for physical activity timing are required.

A socio-ecological model of factors influencing physical activity in pregnant women: a systematic review

“…The publication period ranged from 2004 to 2022, with 20 (62.5%) published after 2019. We found results related to MVPA in pregnant women ( 30 , 31 , 38 , 40 , 45 , 50 , 55 ) in 7 papers. The sample sizes ranged from 22 to 9,345 participants, for a total of 37,920.…”

“…Relative studies contained different contents on a personal level. In addition, 28 papers included socio-demographic factors ( 24 , 25 , 27 , 28 , 30–43 , 45–51 , 53–55 ); 24 included biological factors ( 24–30 , 32 , 33 , 35 , 36 , 39 , 41–44 , 48–55 ); 21 included behavioral factors ( 25–30 , 32 , 33 , 35 , 36 , 39 , 41 , 44–46 , 48–51 , 53 , 55 ); and 19 included psychological factors ( 25 , 27–29 , 31–35 , 42–46 , 49 , 51–53 , 55 ), 32 in total, all of which involved the personal level. There were 24 articles analyzing the interpersonal level ( N = 24) ( 24–30 , 33–35 , 39 , 42–49 , 51–55 ); 18 analyzing the organization level ( N = 18) ( 25 , 27 , 29 , 32–39 , 42 , 44–46 , 51 , 53 , 55 ); 17 articles included factors related to the community level ( N = 17) ( 25 , 27 , 29 , 31–33 , 35 , 37–39 , 44–46 , 51–53 , 55 ); and only 3 articles included factors related the policy level ( N = 3) ( 25 , 33 , 51 ...…”

“…Personal factors included socio-demographic and biological, behavioral, and psychological factors. Age was not considered to be associated with PA in pregnant women ( 28 , 32 , 37 , 40 , 41 , 43 , 54 , 55 ) by most researchers. Being older appears to be associated with higher MVPA compliance ( 24 , 38 , 48 ).…”

“…In one paper, there was a suggestion that PA intensity could be increased by encouraging more PA before pregnancy ( 40 ). Low education ( 32 , 35 , 36 , 43 , 46 , 54 ), first parity ( 29 , 36 , 43 ), lack of knowledge and skills ( 27 , 33 , 44–46 , 53 , 55 ), pregnancy symptoms ( 25 , 27 , 28 , 32 , 33 , 35 , 43 , 44 , 51–53 , 55 ), lack of time ( 25 , 27 , 33 , 39 , 44 , 53 ), low income ( 27 , 33 , 39 , 45 , 51 , 53 ), lack of motivation/goal ( 25 , 51 , 53 , 55 ), and safety concerns ( 25 , 27 , 29 , 31 , 33 , 34 , 44–46 , 49 , 51 , 53 , 55 ) were all identified by the researchers as barriers. The lack of time mainly came from family commitments ( 44 ), while low education, first parity, and lack of knowledge and skills were all related to safety concerns.…”

“…It was also reported that conflicting advice regarding PA from healthcare professionals and family members was confusing ( 44 ). The public was unanimously cited as a barrier factor ( 29 , 35 , 45 , 51 , 53 , 55 ), and physically active women were more often criticized than praised for being active during pregnancy. Women commonly felt stared at, avoided, and treated differently during pregnancy, and often felt treated as if they were infirm or disabled, and that their pregnancy was viewed as a disease ( 29 ).…”